Summary:
The Manager of Revenue Cycle reports to the Director of Revenue Cycle. Responsible for timely and accurate billing claim submission to all responsible payers for all billable services provided. Responsible for the contracted services related to Host Home/ Family Model Services, adaptive aides, and all other ancillary services.
Essential Duties and Responsibilities:
- Responsible for the oversight insurance follow-up, and billing and collection of patient balances.
- Identifies, analyzes, and addresses challenges and/or breakdowns in the revenue cycle process.
- Perform ongoing trend analysis of payer rejections and denials.
- Perform proactive audits on all recommended A/R write- offs.
- Assist with review of contracted rates versus reimbursements.
- Creates and develops reports to address management needs; analyze information to identify trends or issues.
- Ongoing process improvement analysis; and implementation of system improvements.
- Proactively evaluates processes; recommend and implement action plan(s) for change; follows through to ensure effective, sustainable change. Participates in the development and implementation of new procedures and the review and revision of existing procedures.
- Analyzes operations to avoid unnecessary denials and write-offs, decrease aging, and identify problematic activity.
- Identifies opportunities and takes action to build strategic relationships between one’s area and other areas, teams, departments, and units to achieve business goals.
- Supervises employees, assigns, and schedules work: monitors work performance; and handles personnel operations including interviewing, hiring, training new personnel, performance appraisals, promotions, transfers, dismissals, paid time off, and approval/preparing time sheet.
Skills, Knowledge, and Competencies
- Strong analytical and organizational skills.
- Knowledge of government and reimbursement regulation requirements and organization policies, procedures, and systems including knowledge of computer systems and applications.
- Well-developed managerial skills necessary to plan, organize and manage accounts receivable and business operations.
- Well-developed leadership and interpersonal skills including team building, negotiation, consultation, and the ability to communicate well with a variety of patients, family members, medical group staff, providers, and external agencies in a professional manner.
- Excellent written, verbal, and presentation skills necessary to facilitate accurate communication with providers and staff.
- Ability to analyze, interpret and summarize contracts, and regulations.
- Act as a problem solver who can identify problems; recommend options and appropriate solutions.
- Model strong team-building skills.
- Demonstrated ability to effectively set priorities and meet commitment.
Qualifications:
- Bachelor’s degree in healthcare, Business Administration, or related field; or
- Four (4) years of related experience in lieu of degree
- Five (5) years of experience in revenue cycle in a healthcare setting
- Two (2) years of management experience